Nancy J. Arthur

DEVELOPMENT OF BRIEF STRESS MANAGEMENT SUPPORT GROUPS FOR COUPLES UNDERGOING IN VITRO FERTILIZATION TREATMENT

OBJECTIVE To develop and assess the efficacy of couples stress management groups offered concurrently with IVF treatment. DESIGN Couples in IVF treatment were given the option of participating in a biweekly stress management group. SETTING The IVF treatment clinic at Wilford Hall Medical Center, San Antonio, Texas. PATIENT(S) One or both members of 17 couples participated in the program in one of four group cycles. INTERVENTION(S) A cognitive behavioral treatment model was used to help couples process their feelings and cognitions about the impact of infertility on their life and explore their expectations about their future options for becoming parents. MAIN OUTCOME MEASURE(S) Couples were asked to anonymously evaluate the efficacy of the group after they had completed their IVF cycle. RESULT(S) Participants reported that the group helped them deal with the stress of infertility and that they valued the social bonds they formed with other group members. CONCLUSION(S) These data suggest that brief focused group therapy, offered while couples are undergoing IVF, is an effective way to help people deal with the stress of infertility treatment.

Efficacy of brief couples support groups developed to manage the stress of in vitro fertilization treatment

OBJECTIVE To assess the efficacy of brief couples support groups offered concurrently with in vitro fertilization (IVF) treatment. PATIENTS AND METHODS Couples in IVF treatment were given the option of participating in a biweekly support group at the IVF clinic at Wilford Hall Medical Center, San Antonio, Tex. At least 1 member of 26 couples participated in the brief couples support groups, and at least 1 member of 19 other couples completed the questionnaires but did not attend the support group sessions and so comprised the control group. Facilitators used cognitive behavioral techniques to help participants process their feelings and cognitions about their infertility. Emotional and cognitive factors were assessed both before and after group attendance by using the Beck Depression Inventory; the Beck Anxiety Inventory; the Life Orientation Test, which assesses optimism and pessimism; the Survey of Personal Views, which measures irrational beliefs; and the Social Provisions Scale, which measures social support. RESULTS Women who attended group sessions were significantly less anxious after the IVF treatment than they were before the cycle (P < .001). Men who attended the group sessions were more optimistic than nongroup men or the women at the completion of the IVF cycle (P < .001) but endorsed greater numbers of irrational beliefs (P < .001). CONCLUSIONS Despite the fact that the service was relatively inexpensive compared with IVF in the civilian community, the complexity of IVF treatment and the logistic and psychological stress experienced by couples made it hard to form and maintain such groups. Nevertheless, both men and women derived psychological benefit from the group: women reported less anxiety and men greater optimism on completion of the group sessions.

Impact of day 3 or day 5 embryo transfer on pregnancy rates and multiple gestations

OBJECTIVE To test the hypothesis that day 5 ET (D5ET) is superior to day 3 ET (D3ET) in pregnancy outcome and that it also reduces multiple gestations. DESIGN Retrospective cohort study. SETTING Assisted reproductive technologies program at Wilford Hall Medical Center. PATIENT(S) Patients electing for either D3ET or D5ET. INTERVENTION(S) Participants meeting inclusion criteria for D5ET elected either D3ET or D5ET. MAIN OUTCOME MEASURE(S) Cycles were compared by day of transfer and further stratified by patient age (<35 years and 35-40 years). The number of oocytes retrieved, embryos on day 3, embryos transferred, pregnancy rate, implantation rate, and twin and high order multiples (>or=triplets) rates were compared. RESULT(S) Of the 274 patients who met our inclusion criteria, 153 underwent a D3ET and 121 underwent a D5ET. The D5ET group had a significantly lower mean age and number of embryos transferred and a higher implantation rate (56% vs. 42%) than the D3ET group. Patients who were 35-40 years old had a significantly higher live-birth rate (68% vs. 40%). Although not statistically significant, the D5ET groups had higher clinical pregnancy (73% vs. 65%) and twin pregnancy (33% vs. 25%) rates. CONCLUSION(S) Blastocyst transfer resulted in fewer embryos transferred, with a trend toward improved clinical pregnancy and higher twin pregnancy rates. Live-birth rates were improved in patients 35-40 years of age. Younger patients opting for D5ET should do so with a commitment toward single ET.